FOR STUDENTS ENROLLED OR PLANNING TO ENROLL AT PENN STATE
ERIE, THE BEHREND COLLEGE

Consideration for this scholarship shall be given to
undergraduate students enrolled or planning to enroll at Penn
State Erie, The Behrend College, who are in good academic
standing. First preference shall be given to children or
relatives of employees leased to T.W.L. Corporation or its
successors; and employees leased to T.W.L. Corporation or its
successors.

DO NOT COMPLETE
THIS FORM UNLESS YOU OR A FAMILY MEMBER ARE EMPLOYED BY T.W.L. CORPORATION.

First Name:
Mid Init:

Last Name:

Email:

Home/Permanent Address 1 :

Home/Permanent Address 2:

City:
State: Zip:

Name of Family Member Employed
by T.W.L. Corporation:

Relationship to Student:

RELEASE STATEMENT:

In accordance with the Family Educational Rights and Privacy Act of 1974 (FERPA), I hereby authorize the Pennsylvania State University to release personally identifiable information from my education records, including but not limited to major, activities, grade point average, financial need information, and other information to donors who will be considering me for the scholarship for which I have applied. This release of information is necessary for the selection process for the award. I also authorize the University to periodically release personally identifiable information to the scholarship donor for the purpose of updating the donor on my progress at the University. I also authorize the release of personally identifiable information to the public through a press release; newsletter announcement; or a banquet or program booklet. I understand that (1) I have the right not to consent to the release of my education records under FERPA; (2) I have the right to receive a copy of such records upon request; (3) and that this consent shall remain in effect until revoked by me, in writing, and delivered to the Penn State Behrend Financial Aid Office.

I
understand that scholarship awards may be adjusted or revoked
due to unsatisfactory academic progress, change in enrollment
status, ceased enrollment at Penn State Behrend, or otherwise
failing to meet the guidelines of the awarded scholarship.